POS0835 EFFECTIVENESS AND SAFETY OF JAK INHIBITORS IN RHEUMATOID ARTHRITIS-INTERSTITIAL LUNG DISEASE. NATIONAL MULTICENTER STUDY OF 57 PATIENTS
Authors: A. Serrano-Combarro, B. Atienza-Mateo, J. A. Valero Jaimes, M. Pastor Mena, R. Melero, D. Castro-Corredor, M. Martin Lopez, S. Castañeda, J. Loarce-Martos, N. Mena-Vázquez, M. D. C. Carrasco Cubero, C. Díez, A. García-Valle, G. Bonilla, J. M. Blanco, N. Del-Val, N. Vegas-Revenga, L. Pérez Albaladejo, R. Ortega Castro, D. Palma Sanchez, A. M. Fernandez Ortiz, P. López Viejo, M. A. López Lasanta, M. Garijo Bufort, I. Casafont-Solé, O. Maiz, J. Moreno Morales, A. Urruticoechea-Arana, C. Pérez, J. Rosas, D. Ferrer, R. Blanco
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). Abatacept and rituximab are the recommended drugs <b>[1-2].</b> JAK inhibitors (JAKi) have demonstrated efficacy in RA. However, in clinical trials patients with active ILD were usually excluded. Moreover, a warning on ILD toxicity is included in SmPC (Summary of Product Characteristics) with tofacitinib (TOFA). Nonetheless, evidence on efficacy of JAKi in RA-ILD is growing <b>[3].</b> <h3>Objectives</h3> to assess <b>a</b>) the effectiveness and <b>b</b>) the safety of JAKi in AR-ILD patients. <h3>Methods</h3> National multicenter study of 57 RA-ILD patients on treatment with JAKi. We analyzed from baseline the following outcomes: <b>a</b>) forced vital capacity (FVC), <b>b</b>) diffusing capacity of the lungs for carbon monoxide (DLCO), <b>c</b>) chest high resolution computed tomography (HRCT), <b>d</b>) dyspnea (modified Medical Research Council scale), <b>e</b>) arthritis activity (DAS28-ESR or clinical records), and <b>f</b>) sparing corticosteroids effect. <h3>Results</h3> We studied 57 patients (37 women/ 20 men; mean age 66 ±10 years) from clinical practice on treatment with JAKi [baricitinib (BARI)= 42 (74%), TOFA= 6 (11%), upadacitinib (UPA)= 8 (14%), filgotinib (FILGO)= 1 (2%)]. Baseline demographic and clinical characteristics are shown in <b>Table 1</b>. All patients had received disease-modifying antirheumatic drugs (DMARDs) before JAKi [Methotrexate (49,86%), Leflunomide (37, 65%), Sulfasalazine (14, 25%), Hydroxychloroquine (13, 23%), Abatacept (32, 56%), Tocilizumab (14, 25%) and Rituximab (10, 18%)]. Since most patients were on BARI we focused on this group (n=42). Median [IQR] ILD duration up to BARI initiation was of 42 [13-62] months. Mean baseline values of FVC and DLCO (% predicted) were 87±22 and 71±21, respectively. Patients were followed-up for a mean of 37 ±37 months. The evolution of FVC and DLCO remained stable during the first 12 months (<b>Figure 1).</b> At the end of the follow-up, available chest HRCT images improved/ stabilized in 82% of patients. Stabilization or improvement of dyspnea was found in 87% of patients. Most patients showed articular remission or low activity. BARI was withdrawn in 12 (29%) patients due to articular inefficacy (n=11) and development of hypersensitivity pneumonitis (n=1). <h3>Conclusion</h3> JAKi, especially BARI, may be useful and safe in controlling the course of both pulmonary and joint disease in RA-ILD patients, even in refractory cases. <h3>References</h3> [1]Fernández-Díaz C, et al. Rheumatology (Oxford). 2020 Dec 1;59(12):3906-3916. [2]Atienza-Mateo B, et al. J Clin Med. 2020 Sep 23;9(10):3070. [3]Tardella M, et al. Inflammopharmacology. 2022 Jun;30(3):705-712. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Ana Serrano-Combarro: None declared, Belén Atienza-Mateo: None declared, Jesús Alejandro Valero Jaimes: None declared, MARTA PASTOR MENA: None declared, Rafael Melero: None declared, David Castro-Corredor: None declared, MARIA MARTIN LOPEZ: None declared, Santos Castañeda: None declared, Jesús Loarce-Martos: None declared, Natalia Mena-Vázquez: None declared, Maria del Carmen Carrasco Cubero: None declared, Carolina Díez: None declared, Andrea García-Valle: None declared, Gemma Bonilla: None declared, J M Blanco: None declared, N. Del-Val: None declared, Nuria Vegas-Revenga: None declared, Lorena Pérez Albaladejo: None declared, Rafaela Ortega Castro: None declared, DESEADA PALMA SANCHEZ: None declared, ANA MARIA FERNANDEZ ORTIZ: None declared, Patricia López Viejo: None declared, María América López Lasanta: None declared, Marta Garijo Bufort: None declared, Ivette Casafont-Solé: None declared, Olga Maiz: None declared, Juan Moreno Morales: None declared, ANA URRUTICOECHEA-ARANA: None declared, Carolina Pérez: None declared, Jose Rosas: None declared, Diego Ferrer: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, lilly, Bristol-Myers, Janssen, Galapagos and MSD., Consultant of: Abbvie, Pfizer, Roche, lilly, Bristol-Myers, Janssen and MSD., Grant/research support from: Abbvie, MSD, novartis and Roche.